Healthcare Provider Details

I. General information

NPI: 1487672135
Provider Name (Legal Business Name): CHERYL ANN CORRAO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERYL ANN WHITNEY PA-C

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 COLCORD ST
SOUTH BERWICK ME
03908-1004
US

IV. Provider business mailing address

789 CENTRAL AVE
DOVER NH
03820-2526
US

V. Phone/Fax

Practice location:
  • Phone: 207-384-4949
  • Fax: 207-384-5700
Mailing address:
  • Phone: 207-384-4949
  • Fax: 207-384-5700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-420
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0402
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: